气道压力释放通气减轻急性呼吸窘迫综合征肺损伤  

Airway pressure release ventilation relieves lung injury caused by acute respiratory distress syndrome

作　　者：提俊响[1] 韩冠杰[2] 李家琼[2] 李茂琴[2] 许铁[3] 

机构地区：[1]徐州医学院研究生学院,江苏徐州221004 [2]徐州市中心医院ICU,江苏徐州221009 [3]徐州医学院附属医院急救中心,江苏徐州221002

出　　处：《徐州医学院学报》2015年第2期78-81,共4页Acta Academiae Medicinae Xuzhou

基　　金：徐州市医学领军人才资助项目（XM12B036）;徐州市科技局社会发展资助课题（XFIOC019）

摘　　要：目的：评价气道压力释放通气（APRV）和同步间歇指令通气（SIMV）2种不同的机械通气模式对于急性呼吸窘迫综合征（ ARDS ）患者临床疗效的影响。方法将24例接受有创机械通气的ARDS患者随机分为SIMV组和APRV组，2组均采用肺保护性通气策略，予合理使用抗生素，适当镇静、镇痛，脏器功能支持，维持内环境稳定等综合治疗。监测动脉血气、动态肺顺应性（Cdyn）及肺血管外肺水指数（ELWI）指标，检测血浆肿瘤坏死因子（TNF）α、白细胞介素（IL）6水平，并记录24 h芬太尼和咪达唑仑用量、液体平衡量及血管活性药物用量。结果与SIMV组相比，APRV组通气24 h后氧合指数（PaO2／FiO2）及Cdyn改善（P＜0．05或P＜0．01），TNF －α、IL－6、ELWI降低（P＜0．01），24 h芬太尼、咪达唑仑用量及液体正平衡量明显减少（P＜0．01）。结论 APRV能改善患者的氧合状态及Cdyn，减轻炎症反应，降低ELWI，减少镇静剂用量及液体正平衡量。Objective To evaluate the effects of airway pressure release ventilation （ APRV） and synchronized in-termittent mandatory ventilation （ SIMV ） on the clinical efficacy in patients with acute respiratory distress syndrome （ARDS）.Methods Twenty-four ARDS patients were randomized to receive SIMV （n=12） or APRV （n=12）.Both groups underwent a combined therapy including rational use of antibiotics , appropriate sedation , supports of organ func-tion and homeostasis maintenance under a lung protective ventilation strategy .All patients were monitored for arterial PaO2 and PaCO2, oxygen index （PaO2/FiO2）, dynamic compliance of the lungs （Cdyn） and extravascular lung water in-dex （ELWI）.Meanwhile, the levels of TNF-αand IL-6 in plasma were measured using enzyme -linked immunosor-bent assay （ELLSA）.Also, the doses of fentanyl and midazolam for 24 hours, total fluid balance and vasoactive drug do-ses were recorded .Results Compared with the SIMV group , those receiving APRV presented significantly improved val-ues of PaO2/FiO2 and Cdyn 24 hours after mechanical ventilation （P〈0.05 or P〈0.01）, reduced levels of TNF -α, IL-6 and ELWI （P〈0.01 ）, as well as obvious decreases in the doses of fentanyl , midazolam, and vasoactive drugs and positive fluid balance volume （P〈0.01）.Conclusion After APRV, patients are in an improved oxygenation status with reduced values of Cdyn and ELWI as well as weakened inflammation and positive fluid balance volume who also re -quire less doses of sedatives .

关 键 词：急性呼吸窘迫综合征 气道压力释放通气 同步间歇指令通气 自主呼吸 

分 类 号：R563.9[医药卫生—呼吸系统]